Valsalva Retinopathy Follow-up

  • Author: Robert S Duszak, OD, FAAO; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 16, 2012
 

Further Inpatient Care

  • Inpatient care may be required if indicated by the medical workup.[32]
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Further Outpatient Care

  • Depending on the magnitude of the retinopathy, various follow-up schedules may be used accordingly.
    • Typically, for those patients who are being observed, follow-up care is at 1 week, 1 month, and 3 months following the initial incident. Wide variations in the timing and the frequency of follow-up care, depending on the location, the severity, and the underlying cause of the hemorrhage, are not uncommon.
    • For those patients who have undergone a laser membranotomy, follow-up care is usually arranged at 24 hours, 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months. This schedule may vary depending on individual circumstances.
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Deterrence/Prevention

  • To prevent a rebleed, physical activity should be limited immediately following detection until the retina has healed.
  • A medical workup, as suggested by the individual's history and physical examination, to look for precipitating factors may be helpful in detecting underlying diseases or contributing causes that are preventable or treatable.
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Complications

  • Although most patients who are managed with observation alone heal without complications, slightly reduced visual acuities secondary to either incomplete blood resorption or mild retinal pigment epithelium changes in or around the macula have been reported.
  • A slowly resolving subhyaloid hemorrhage prolongs contact of the retina with hemoglobin and iron, possibly causing toxic damage to the retina and reducing visual function, which may be irreversible.
  • One incidence has been reported of a bilateral choroidal detachment occurring after a Valsalva maneuver.
  • An Nd:YAG laser membranotomy has produced epiretinal membrane formation with internal limiting membrane wrinkling as a late postoperative complication, although its frequency has not yet been identified.
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Prognosis

  • The prognosis for patients with pure Valsalva retinopathy is generally good with observation alone. Vision usually returns to normal over a short period of time, from weeks to months.
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Patient Education

  • While lifting heavy objects, patients should be advised not to hold their breath for extended periods of time and to take multiple breaths between bearing-down phases. Exhaling while lifting or straining prevents a Valsalva maneuver because one cannot exhale against a closed glottis. Straining during bowel movements should be avoided.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Subconjunctival Hemorrhage (Bleeding in Eye).
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Contributor Information and Disclosures
Author

Robert S Duszak, OD, FAAO  Attending, Philadelphia Veterans Affairs Medical Center; Consulting Staff, Nemours Health Clinic, Mayfair Eye Associates; Adjunct Clinical Faculty, Eye Institute of the Pennsylvania College of Optometry

Robert S Duszak, OD, FAAO is a member of the following medical societies: American Academy of Optometry, American Geriatrics Society, and American Optometric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Initial presentation of a Valsalva retinopathy less than 24 hours following a Valsalva maneuver in an 18-year-old man. Note the large preretinal hemorrhage. Vision was finger counting at 5 feet.
At 4-month follow-up of the same patient as in the image above, most of the large preretinal hemorrhage had cleared with observation alone. Note the wrinkled internal limiting membrane temporal to the macula and the resolving hemorrhage at the edge of the demarcation line of the stretched internal limiting membrane inferiorly. Vision had returned to 20/20.
A large preretinal hemorrhage in a 42-year-old man following a Valsalva maneuver. This image was taken 2 days after he underwent heavy straining while lifting weights.
This 58-year-old man with uncontrolled diabetes presented with complaints of a spot in his vision following straining during a bowel movement. He had active proliferative diabetic retinopathy, and the hemorrhage shown in this image stems from a broken neovascularized blood vessel secondary to a Valsalva maneuver.
 
 
 
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